| Final Order / Judgement | DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, BATHINDA C.C. No. 15 of 16-01-2018 Decided on : 2-12-2021 Jasvir Singh aged about 38 years S/o Sh. Bharpur Singh R/o Vill. Muhallan, Near Sangat Mandi, District Bathinda, Now R/o H. No. 22655, Main Road, Opp. Gali No. 7, Bhagu Road, Bathinda 151 001. ........Complainant Versus United India Insurance co. Ltd., Divisional Office, The Mall, Bathinda, through its Divisional Manager .......Opposite party
Complaint under Section 12 of the Consumer Protection Act, 1986 QUORUM Kanwar Sandeep Singh, President Sh. Shivdev Singh, Member. Smt. Paramjeet Kaur, Member Present For the complainant : Sh. Naresh Garg, Advocate For opposite party : Sh. M L Bansal, Advocate. ORDER Kanwar Sandeep Singh, President The complainant Jasvir Singh (here-in-after referred to as complainant) has filed this complaint U/s 12 of Consumer Protection Act, 1986 (Now C.P. Act, 2019, here-in after referred to as 'Act') before this Forum (Now Commission) against United India Insurance Co. Ltd., (here-in-after referred to as opposite parties). Briefly stated, the case of the complainant is that he is the owner of Maruti Suzuki Swift ZDI Vehicle bearing Registration. No.PB-03-AF-0752. The said vehicle was duly hypothecated with SBI Sangat and now total loan is clear and now there is no hypothecation. The said car is comprehensively insured vide Insurance Certificate No. 2004003116P106237314 w.e.f. 10-08-2016 to 09-08-2017 with the opposite party for the IDV of Rs. 4,50,000/-. The opposite party fixed the IDV of Rs,4,50,000/- and charged Rs.11,827/- from the complainant. The opposite party also charged Rs. 2153-93, in the premium as they issued DEP CAP i.e. Nil Depreciation policy. It is alleged that on 10-05-2017 the said car met with an accident in the revenue limits of Police Station Sangat District Bathinda and in this regard DDR No. 22 dated 13-05-2017 was registered. At that time, the vehicle was being driven by Gurmander Singh. The car was struck with road side tree, as such, it was completely damaged (total loss) and driver also received injuries. The complainant informed the police of PS Sangat. The complainant thereafter remained busy in necessary agriculture work and he informed the opposite party on 05-07-2017. The vehicle was shifted with M/s Modern Motors under the instructions of opposite party after spending Rs.1500/- as towing charges. The opposite party appointed Mr. Dinesh Kumar Goyal surveyor, who visited the workshop and surveyed the vehicle and assessed the loss to the tune of Rs, 3,52,000/- against IDV of Rs. 4,50,000/- whereas the vehicle is total loss as the estimates issued by the authorized centre was to the tune of about Rs. 5,48,219/- and it is also stated that the insurance is 0% depreciation policy. The estimated loss is beyond the IDV and exceeds the clause of GR -8 as the same is more than 75% which means the vehicle is total loss. The complainant submitted all the necessary papers i.e. photocopy of RC, photocopy of insurance certificate, photocopy of DL of Gurmander Singh and DDR etc., to the opposite party through Er. Dinesh Kumar Goyal Surveyor. It is alleged that the opposite party issued one letter dated 07-11-2017 to the complainant and rejected the legal claim of the complainant with remarks that the claim is not intimated in time as the intimation was given to Insurance company after one month 26 days. The opposite party issued this letter against the rules of IRDA issued on 20-09-2011. However, I.R.D A already issued the guidelines to all the companies who issue the Insurances that no claim will be rejected on the basis of late intimation, if the same is genuine. The opposite party illegally and on flimsy ground rejected the legal claim of Rs, 4,50,000/- ( IDV) and Rs, 1500/- as Towing charges of the complainant by using clause late intimation. However, in this case there is no delay as the complainant already informed the police. Moreover the opposite party never communicated such type of clause nor produced any insurance policy till date. Due to non payment of the claim i.e. Rs.4,50,000/- and Rs,1500/- by the opposite party due to the wrong acts and conducts of the opposite party, the complainant has suffered mental agony and pains for which he claims compensation to the tune of Rs,1,00,000/-. The opposite party failed to provide services and sitting over the claim of the complainant and illegally rejected the genuine claim. On this backdrop of facts, the complainant has prayed for directions to the opposite party to pay total loss amount of Rs. 4,50,000/- (IDV of the car) plus Rs. 1500/- as Towing charges alongwith interest @ 18% p.a. in addition to compensation to the tune of Rs. 1,00,000/- besides Rs. 50,000/- as litigation expenses. Upon notice the opposite party put in appearance through counsel and contested the complaint by filing written reply. In written reply, the opposite party raised legal objections that complaint has been filed by the complainant only to injure the goodwill and reputation of the opposite party. Even otherwise, the complaint is false, frivolous and vexatious to the knowledge of the complainant and as such the opposite party is entitled to special costs from the complainant and that the complainant has concealed material facts and documents from this Commission. It has been pleaded that on the receipt of intimation regarding the alleged accident which took place on 10-05-2017 and reported to the opposite party on 05-07-2017 i.e. after delay of one month 26 days , the opposite party deputed Er. Dinesh Kumar Goyal, who submitted his preliminary report and assessed the loss on different counts, subject to final approval from the competent authority. While processing the claim, it revealed that insured has violated the terms and conditions of the policy. The complainant has failed to give notice as per condition No. 1 of insurance policy, within a reasonable period, so his claim has already been repudiated by the competent authority. Further legal objections are that the claim of the complainant has been rightly repudiated after thorough investigation and as per terms and conditions of the policy, so this Commission has got no jurisdiction to try and entertain the complaint; that the complainant has no locus standi or cause of action to file the present complainant; that the complaint is not maintainable in its present form; that the complainant is estopped by his own act, conduct and acquiescence from filing the present complaint and that there is no deficiency in services or unfair trade practice on the part of opposite party. On merits, the opposite party admitted that the said vehicle was insured with the opposite party, but it is pleaded that the insurance was subject to terms and conditions of the policy and the claim, if any is payable only as per terms and conditions of the policy. The opposite party further pleaded that the complainant himself has declared the IDV of the vehicle to be Rs.4,50,000/-. It is also pleaded that a false story has been manipulated by complainant just to cover the delay in giving intimation to the opposite party regarding the alleged accident. Thereafter the opposite party reiterated its version as pleaded and detailed in legal objections above. It is also pleaded that The complainant has not suffered any loss as alleged, rather the opposite party is suffering at the hands of complainant and as such, it is entitled to special costs to the tune of Rs,10,000/-. After controverting all other averments, the opposite party prayed for dismissal of complaint. In support of his complaint, the complainant has tendered into evidence affidavit of Jasvir Singh dated 23-03-2018 (Ex.C-1), photocopy of certificate of insurance (Ex.C-2), photocopy of general diary detail (Ex.C-3), photocopy of letter (Ex.C-4), photocopy of bill (Ex.C-5), photocopy of estimate containing 1 to 7 pages (Ex.C-6) and closed the evidence. In order to rebut the evidence of complainant, the opposite party tendered into evidence affidavit of Baldev Singh, Senior Divisional Manager dated 07-05-018 (Ex.OP1/1), photocopy of insurance policy (Ex.OP1/2), photocopy of survey report (Ex.OP1/3,) photo copy of final survey report (Ex.OP1/4), Photocopy motor claim forms (Ex.OP1/5), photocopy of letter dated 07-11-2017(Ex.OP1/6), photocopy of claim note (Ex.OP1/7), photocopy of inspection report (Ex.OP1/8),photocopy of legal opinion (Ex.OP1/9), photocopy of DDR (Ex.OP1/10),photocopy of letter dated 15-09-2017 (Ex.OP1/11), photocopy of claim intimation (Ex.OP1/12) photocopy of affidavit of Jsbir Singh dated 12-07-2017 and closed evidence. We have heard learned counsel for the parties and gone through the record. These are undisputed facts between the parties that Maruti Suzuki Swift ZDI Car bearing registration No. PB-03-AF-0752 of complainant was insured with opposite party vide Insurance Certificate No. 2004003116P106237314 w.e.f. 10-08-2016 to 09-08-2017 for the IDV of Rs. 4,50,000/- (Ex. C-1). The said car met with an accident on 10-5-2017. DDR No. 22 dated 13-5-2017 (Ex. C-2) was registered in this regard. The complainant intimated the loss to the opposite party on 5-7-2017 and the opposite party deputed spot surveyor as well as final Surveyor, who inspected the damaged vehicle in question and submitted their survey reports to the opposite party. The opposite party repudiated the claim of the complainant vide letter dated 7-11-2017 (Ex. C-4). A perusal of aforesaid repudiation letter (Ex. C-4) reveals that the opposite party repudiated the claim of the complainant on the ground that he intimated the loss to the opposite party after one month 26 days which is violation of condition No. 1 of Insurance policy. The complainant has pleaded that terms and conditions of policy were not supplied to him. The opposite party has not produced any evidence on file to prove that terms and conditions of the policy in question were supplied to the complainant. The onus was upon opposite party to prove violation of condition No. 1 of Insurance policy but to the utter surprise the opposite party has not produced on file said condition No. 1 of policy. After accident, the complainant got DDR registered on 13-5-2017 (Ex. C-3), wherein date of accident and its cause is mentioned. The complainant intimated the loss to the opposite party, although late by one month 26 days, and the opposite party deputed surveyors. Preliminary/Final Survey Report of Er. Dinesh K Goyal (Ex. OP-1/3 & Ex. OP-1/4) and Revaluation Report of Er Ashok Kumar Bansal (Ex. OP-1/11) are produced on file by the opposite party. None of the aforesaid report reveals any bad intention or malafide on the part of complainant rather surveyors have found the case as genuine after verification of each factor in connection with damage to vehicle and recommended total loss. The I.R.D.A has issued circular regarding delay in claim intimation/documents submissions. For the sake of convenience, the circular is being reproduced as under :- “ Ref No. IRDA/HLTH/MISC/CIR/216/09/2011 Dated 20-09-2011 C I R C U L A R To : All life insurers and non-life insurers. Re : Delay in claim intimation/documents submission with respect to i) All life insurance contracts and ii) All Non-life individual and group insurance contracts. The Authority has been receiving several complaints that claims are being rejected on the ground of delayed submission of intimation and documents. The current contractual obligation imposing the condition that the claims shall be intimated to the insurer with prescribed documents within a specified number of days is necessary for insurers for effecting various post claim activities like investigation, loss assessment, provisioning, claim settlement etc. However, this condition should not prevent settlement of genuine claims, particularly when there is delay in intimation or in submission of documents due to unavoidable circumstances. The Insurers' decision to reject a claim shall be based on sound logic and valid grounds. It may be noted that such limitation clause does not work in isolation and is not absolute. One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely technical grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation. Therefore, it is advised that all insurers need to develop a sound mechanism of their own to handle such claims with utmost care and caution. It is also advised that the insurers must not repudiate such claims unless and until the reasons of delay are specifically ascertained, recorded and the insurers should satisfy themselves that the delayed claims would have otherwise been rejected even if reported in time. The insurers are advised to incorporate additional wordings in the policy documents, suitably enunciating insurers' stand to condone delay on merit for delayed claims where the delay is proved to be for reasons beyond the control of the insured." Hon'ble Supreme Course in the case Om Parkash Vs. Reliance General Insurance & Anr (IV (2017) CPJ 10 (SC) has held that : “Decision of insurer to reject claim has to be based on valid grounds. Rejection of claims on purely technical grounds in a mechanical manner will result in loss of confidence of policy holders in insurance industry. If reason for delay in making a claim is satisfactorily explained, such a claim cannot be rejected on the ground of delay. It would not be fair and reasonable to reject genuine claims which had already been verified and found to be correct by Investigator. Condition regarding delay shall not be a shelter to repudiate insurance claims which have been otherwise proved to be genuine.” The surveyor Er Dinesh K. Goyal in his report Ex. OP-1/3 has mentioned that he inspected the damaged vehicle in question at workshop and net liability of the insurer on repair basis was more than 75% of the IDV and it is a case of total loss. Er. Ashok Kumar Bansal in his Revaluation Report Ex. OP-1/11 has specifically mentioned that during his inspection, he found that the vehicle had very badly damaged and its repairing is not economical. Therefore, in such circumstances, it cannot be said that claim of the complainant is not genuine. A perusal of aforesaid observations reveals that Insurance Companies are not justified to reject the claims on purely technical grounds in a mechanical manner and the condition regarding delay shall not be a shelter to repudiate the insurance claims which have been otherwise proved to be genuine. Therefore, the repudiation on the ground of delay is not justified and there is deficiency in service on the part of the opposite party in repudiating the genuine claim of the complainant. As discussed above, the surveyor Er Dinesh K.Goyal vide his report Ex. OP-1/3 has opined that it is a case of total loss and as per Insurance Certificate (Ex. OP-1/2) of the vehicle in question Insured's Declared Value (IDV) of the vehicle is Rs. 4,50,000/-. Hence, the complainant is entitled to IDV of the vehicle. In view of what has been discussed above, this complaint is partly accepted with Rs. 5,000/- as cost and compensation. The opposite party is directed to pay claim amount of Rs. 4,50,000/- being IDV of the vehicle in question to complainant with interest @ 9% w.e.f. 7-11-2017 (date of repudiation) till realization. The complainant will handover the damaged vehicle in question/salvage to the opposite party. The opposite parties will also be at liberty to obtain any other document, if legally required, for settlement of claim. The compliance of this order be made by opposite party within 45 days from the date of receipt of copy of this order. The complaint could not be decided within the statutory period due to heavy pendency of cases. Copy of order be sent to the parties concerned free of cost and file be consigned to the record. Announced : 2-12-2021 (Kanwar Sandeep Singh) President (Shivdev Singh) Member (Paramjeet Kaur) Member
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